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OBJECTIVE: A lowered energy metabolism in schizophrenia was reported already in the 1920s. However, these early investigations were case studies without control groups or statistical analysis. In this study the resting energy expenditure (REE) and relevant body composition variables were measured in patients with schizophrenia and healthy controls. METHOD: REE was determined in 30 patients and 17 controls. The difference between the measured and the expected level for each individual was calculated as DeltaREE. Body composition was assessed with bioelectrical impedance and calliper measurements. RESULTS: DeltaREE was significantly lower in the patients than in the controls. A decrease was also seen in the non-medicated patients. The patients showed significantly lower percentages of water in fat free-mass and intracellular water. CONCLUSION: The lowering of REE and body water fractions may suggest a homeostatic aberration in schizophrenia that may be of importance for the understanding of metabolic disturbances observed in the disease.

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This article presents the nutrient composition and nutritional contribution of naturally occurring vegetables (NOV) in four villages in Vietnam. The frequency of consumption and quantities eaten were evaluated within the overall diet of 101 and 110 women in the Mekong Delta (flood period and rainy season, respectively) and of 103 women in the Central Highlands (rainy season). The concentrations of Ca, Fe and Zn were analysed in 28 species, and presence of tannins and phytic acid in 19 species. Provitamin carotenoids were determined in 11 species. Over 90% of the women consumed NOV, and they contributed 43, 72 and 75% (Central Highlands, Mekong rainy and Mekong flood period, respectively) of the total quantities of vegetables eaten. Aquatic species such as lpomoea aquatica and Limnocharis flava, and terrestrial vegetables such as Schismattoglottis calyptrata, were among the most commonly consumed vegetables. They were eaten in mean daily quantities exceeding 50 g and had high concentrations of Ca, Fe and beta-carotene. Other major aquatic vegetables included the stems of Eleocharis sp., Nelumbo nucifera and Nymphea lotus, all of which were used as salad vegetables and had relatively low nutrient density. The problems of assessing the current role of NOV due to lack of data on intakes in the context of the overall diets, as well as data on their composition, are addressed.

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The effect of a "normal" (n = 8) and "high" (n = 6) protein intake (1 and 2.5 g x kg(-1) x day(-1), respectively) and of exercise on plasma amino acid (AA) concentrations, insulin, and glucagon concentrations was followed throughout a continuous 24-h period in adult male subjects at energy balance after six days on a standardized diet and exercise program. Subjects were fasting from 2100 on day 6 to 1200 on day 7 and then fed 10 identical meals hourly until 2100. Physical exercise was performed (46% maximal oxygen uptake) between 0830 and 1000 (fasting) and in a fed state (1600-1730) on each day. The normal-protein group showed fasting plasma AA concentrations that were higher (P < 0.05) than those for the high-protein group, except for leucine, methionine, and tyrosine. Glutamine, glycine, alanine, taurine, and threonine concentrations were distinctly higher ( approximately 30% or greater) throughout the 24-h period in subjects consuming the normal- vs. the high-protein diets. Exercise appeared to increase, although not profoundly, the plasma concentrations of amino acids except for glutamate, histidine, ornithine, and tryptophan. The profound diet-related differences in plasma AA concentrations are only partially explained by differences in the renal clearance of the amino acids. We speculate on the possible metabolic basis for these findings.

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The quantitative relationships between nitrogen (N) intake, urea production, excretion and amino acid oxidation are currently a matter of debate. Some investigators have proposed that urea production is essentially constant over a wide range of N intakes and that urea hydrolysis is regulated according to the N needs of the organism. We have assessed this proposal by compiling results from four separate experiments in healthy young adults (n = 34) carried out in our laboratories and all at the end of the respective diet periods using an identical 24-h continuous intravenous infusion of [(15)N, (15)N]urea and L-[1-(13)C]leucine. The N intakes were: expt. 1; protein-free diet for 5 d; expt. 2; N at 44 mg N. kg(-1). d(-1) from a balanced L-amino acid mixture for 13 d; expt. 3; N at 161 mg. kg(-1). d(-1) from egg protein for 6 d; expt. 4 -one group received 157 mg. kg(-1). d(-1) and the other 392 mg. kg(-1). d(-1) from milk-protein-based diets for 6 d. Urea production and excretion were linearly correlated with N intake (r = 0.98 and 0.94, respectively; P < 0.01). Urea hydrolysis increased linearly with N intake (r = 0.7; P < 0.05), with considerable variation in the rate among individuals, especially at the N intake of approximately 160 mg N. kg(-1)d(-1). These findings are consistent with the generally accepted view that a control of body N balance is via a regulation of urea production. They do not support the concept that urea hydrolysis is the more important site in the control of body N loss.

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BACKGROUND: Deficiencies of iodine, iron, and vitamin A are the 3 most common micronutrient deficiencies in developing countries, although control programs, when properly implemented, can be effective. OBJECTIVE: We investigated these deficiencies and their possible interaction in preschool children in the southern Blue Nile area of Sudan. DESIGN: Goiter, signs of vitamin A deficiency, and biochemical markers of thyroid, vitamin A, and iron status were assessed in 984 children aged 1-6 y. RESULTS: The goiter rate was 22. 3%. The median urinary iodine concentration was 0.79 micromol/L and 19.3% of the children had a concentration >1.57 micromol/L. Although serum thyroxine and triiodothyronine concentrations were within reference ranges, the median thyrotropin concentration was 3.78 mIU/L and 44% of the children had thyrotropin concentrations above normal. The mean urinary thiocyanate concentration was high (259 +/- 121 micromol/L). The prevalences of Bitot spots and night blindness were 2.94% and 2.64%, respectively, and 32% of the subjects had serum retinol binding protein concentrations <15 mg/L. A significant positive correlation was observed between thyrotropin and retinol binding protein. Whereas 88% of the children had hemoglobin concentrations <1.86 mmol/L, only 13.5% had serum ferritin concentrations below the cutoff of 12 microg/L and 95% had serum transferrin concentrations above the cutoff of 2.50 g/L. CONCLUSIONS: Our results indicate that goiter is endemic in this region of Sudan despite iodine sufficiency and that both anemia and vitamin A deficiency are health problems in the area. Moreover, consumption of millet, vitamin A deficiency, and protein-energy malnutrition are possible etiologic factors in this endemic area.

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Fe seems to be the only nutrient deficiency that industrialized and low-income countries have in common. Thus, Fe is one of the most critical nutrition requirements to be met in most diets in human subjects. Fe deficiency is caused not only by too low an intake, but is also the result of low bioavailability, as well as an increased Fe requirement due to physiological variables or clinical problems which are not met by an increased dietary intake of Fe. In low-income countries poor dietary quality rather than Fe intake seems to be the key determinant of impaired Fe status. Sometimes the Fe intake even exceeds that in populations of industrialized countries. The interaction of all enhancers (e.g. ascorbic acid and meat), as well as inhibitors (such as bran, polyphenols, egg yolk, soyabean products, Ca, Ca3(PO4)2 and phytic acid (or phytate)) is what determines the bioavailability of non-haem-Fe in the meal. Dietary composition seems to be particularly important when Fe reserves are low, or in the presence of Fe deficiency. Furthermore, the development of anaemia as a result of Fe deficiency, secondary to Fe-stress situations, is dependent on the Fe balance in the host. With respect to the dietary intake of Fe, other products in the food consumed as well as previous treatment of the product (e.g. heat treatment and processing) may also influence bioavailability. Despite all efforts to counteract Fe deficiency it still represents one of the dominant problems in the micronutrient sphere. It is apparent that there is no simple solution to the problem, and the fact that Fe deficiency still occurs in affluent societies consuming a mixed diet speaks for itself a more holistic view of total dietary composition and the role of enhancers and inhibitors is needed.

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Effects of moderate physical activity (90 min at 45-50% of maximal O2 uptake 2 times daily) and "high" (2.5 g protein. kg-1. day-1, n = 6) or "normal" protein intake (1.0 g protein. kg-1. day-1, n = 8) on the pattern and rate of 24-h macronutrient utilization in healthy adult men were compared after a diet-exercise-adjustment period of 6 days. Energy turnover (ET) was determined by indirect and direct (suit) calorimetry, and "protein oxidation" was determined by a 24-h continuous intravenous infusion of [1-13C]leucine. Subjects were in slight positive energy balance during both studies. Protein contributed to a higher (22 vs. 10%) and carbohydrate (CHO) a lower (33 vs. 58%) proportion of total 24-h ET on the high- vs. normal-protein intake. The highest contribution of fat to ET was seen postexercise during fasting (73 and 61% of ET for high and normal, respectively). With the high-protein diet the subjects were in a positive protein (P < 0.001) and CHO balance (P < 0.05) and a negative fat balance (P < 0.05). The increased ET postexercise was not explained by increased rates of urea production and/or protein synthesis.

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In healthy adult men adapted to a diet/exercise regimen for 6 days, the effects of small, frequent meals supplying daily protein intakes of 1 (n = 8) or 2.5 g . kg-1 . day-1 (n = 6) on leucine oxidation, urea production, and whole body protein synthesis (PS) and degradation (PD) have been compared with the use of a 24-h continuous intravenous [13C]leucine and [15N,15N]urea infusion protocol. Two 90-min periods of exercise (approximately 50% maximal O2 consumption) were included during the fasting and the fed periods of the 24-h day. Subjects were determined to be at approximate energy, nitrogen, and leucine balances on both diets. Increased protein intake raised the urea production rate; the absolute rate of urea hydrolysis was the same on both diets. When the first-pass splanchnic uptake of leucine was taken to be 25% of intake, PS was stimulated by feeding (after an overnight fast) at both protein intake levels (P < 0.05 and P < 0.01), whereas PD declined significantly (P < 0.01) at both protein levels. Protein gain at a high protein intake appears to be the result of both a stimulation of PS and a marked decline in PD, whereas at a less generous intake, the gain appears to be a result of a fall in PD with a less evident change in PS. Exercise moderately decreased PS during and/or immediately after exercise at each protein level, and there was a postexercise-induced increase (P < 0.01) in PD, which was more dramatic when feeding was at the higher protein intake level.

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Epidemiological evidence suggests that millet might play a role in the etiology of endemic goiter. Recently, we showed that a traditional fermentation procedure of two pearl millet (Pennisetum americanum L. Lecke) cultivars grown in Sudan modified their effects on the weight of the thyroid gland and thyroid hormone profile in rats. In the present study, we report that this fermentation procedure reduced the ash contents of millet by about 40% and removed considerable amounts of Mg (>50%), Zn (27-39%) and K (45%). Other minerals (Ca, Fe, Cu) were not affected. Feeding of one fermented cultivar resulted in significant reduction in bone Mg and Zn contents, whereas feeding of the other fermented cultivar resulted in reduction of bone Mg only. Dietary Mg intake and bone Mg contents correlated negatively with serum T3. Groups fed the millet diets had higher serum Se level compared to those fed wheat or casein diets and feeding of fermented millet resulted in a further increase in serum Se level. Thus our data indicate that in rats the enhanced effects of millet on the thyroid induced by fermentation is likely related to removal of minerals from millet and/or chemical transformation of the goitrogens contained in millet.

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Short-term metabolic experiments have revealed that physical exercise increases the oxidation of leucine, which has been interpreted to indicate an increased requirement for dietary protein in physically active subjects. Because it may be inaccurate to extrapolate measurements of amino acid oxidation made over a few hours to the entire day, we have carried out a continuous 24-h intravenous [1-13C]leucine/[15N]urea tracer study in eight healthy adult men. Their diet supplied 1 g protein.kg-1.day-1, and exercise (mean maximal O2 consumption 46%) was for 90 min during the 12-h fast and 12-h fed periods of the day. Subjects were adapted to the diet and exercise regimen for 6 days. Then, on day 7, they were dressed in the University of Uppsala energy metabolic unit's direct calorimeter suit, were connected to an open-hood indirect calorimeter, and received the tracers. Exercise increased leucine oxidation by approximately 50 and 30% over preexercise rates for fast and fed periods, respectively. This increase amounted to approximately 4-7% of daily leucine oxidation. Subjects remained in body leucine equilibrium (balance -4.6 +/- 10.5 mg.kg-1.day-1; -3.6 +/- 8.3% of intake; P = not significant from zero balance). Therefore, moderate exercise did not cause a significant deterioration in leucine homeostasis at a protein intake of 1 g.kg-1.day-1. These findings underscore the importance of carrying out precise, continuous, 24-h measurements of whole body leucine kinetics; this model should be of value in studies concerning the quantitative interactions among physical exercise, energy/protein metabolism, and diet in humans.

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Energy turnover during offshore sailing was studied in 11 male crew members of one team during the first three legs of the 1993-1994 Whitbread Round The World Race. The effect of racing on the energy balance of the crew members was studied by anthropometric measurements and dietary intake as calculated from food inventories before and after each leg. Energy turnover, calculated from dietary intake and release of endogenous energy as a result of changes in body composition, was higher than expected (about 18-20 MJ.d-1). These findings were confirmed using the doubly labeled water technique in six crew members during the third leg, in which mean energy turnover was found to be 19.3 MJ.d-1. Changes in body weight and composition indicated a negative energy balance during all legs.

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The purpose of this study was to develop flexible and accurate multicompartment equations to calculate body composition and compare the results with methods using common two-compartment equations. Twenty-two healthy male volunteers 22-59 y of age were studied. Body volume was measured by underwater weighing (UWW) or with a skinfold caliper, bone mineral by dual-energy X-ray absorptiometry (DXA), and body water by bioelectrical impedance analysis (BIA). The percentage of water and bone mineral in fat-free mass (FFM) had a significant effect on the difference in percentage fat obtained by the two-compartment model compared with a four-compartment model. FFM density was negatively (r = -0.76, P < 0.001) and percentage water in FFM was positively correlated with age (r = 0.75, P < 0.001). The three-compartment model based on field-adapted methods (skinfold thickness + BIA) to calculate percentage body fat correlated significantly with the more complex four-compartment model (UWW + BIA + DXA; r = 0.95, P < 0.001). The advantages of three- and four-compartment equations are that they compensate for differences in body content of bone mineral and water.

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Intensive cooling has been shown to increase energy expenditure (EE) during work as well as to decrease physical performance. Two different levels of moderate cooling (10 degrees C vs 15 degrees C) were studied during light endurance exercise in order to examine the effect of the increased heat loss on EE. Twelve subjects performed a 90-min low intensity exercise (100 W) on a cycle ergometer, wearing a water-cooled calorimeter suit for controlled cooling. The lower temperature resulted in a 4.3 +/- 3.8% (mean +/- SD) higher EE, increased total heat loss and lowered skin temperatures. No differences in central core body temperature, heart rate or respiratory quotient (RQ) were recorded. There was a relation between differences in the rate of heat loss and the corresponding increase in EE. Even a small increase in cooling during endurance exercise increased EE which may be a relevant problem in winter sports.

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In addition to factors such as fat free mass, hormonal status, genetics and energy balance, previous physical activity has been shown to influence energy turnover during resting (RMR = resting metabolic rate) or basal conditions (BMR = basal metabolic rate). This article presents data on BMR from elite endurance athletes (4 female and 4 male), at least 39 h after their last training session, in comparison with sedentary nonathletic controls matched for sex and fat free mass (FFM). Comparisons with theoretical calculations of BMR were also made. The athletes were shown to have a significantly higher BMR than was expected from calculations based on body mass (16%, P < 0.05) or body composition (12%, P < 0.05). There were no corresponding differences found in the nonathletic control group. The athletes had a 13% higher (P < 0.001) BMR than controls if related to FFM and 16% (P = 0.001) if related to both FFM and fat mass (FM). The athletes were also found to have 10% lower R-values (P < 0.01) indicating higher fat oxidation. The conformity of these findings with the present literature and the possible mechanisms behind them as well as its influence on theoretical calculations of energy turnover (ET) based on activity factors expressed as multiples of RMR are further discussed.

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